Background: In symptomatic, drug-refractory atrial fibrillation (AF) patients, pulmonary vein isolation (PVI) is an effective treatment technique.  Nevertheless, approximately one third of patients’ experience AF recurrence. Multiple studies suggested that especially female patients have a worse outcome. To further improve the outcome of PVI and to develop possible sex-specific treatment approaches it is essential to reveal the differences of male and female patients undergoing PVI.

Methods: The trial design was an observational single-center study with a blinded retrospective analysis of cardiac computed tomography angiography (CCTA) images. Statistical analysis comprised all relevant baseline characteristics as well as left atrial and left atrial appendage measurement data.

Results: A total of 1.103 patients underwent second generation cryoballoon PVI from May 2012 to September 2016. Prior to the intervention CCTA was conducted in 725 (65.7%) patients of which 473 (65.2%) had sufficient image quality for further measuring and analysis. Mean age was 66.3±9.5 years comprising 284 (60%) male and 189 (40%) female patients. Paroxysmal AF was present in 277 (58.6%) participants. Female patients were older (p<0.001) and had a greater body mass index than male patients (p=0.026). Regarding measurement parameters LA volumes (p<0.001), posterior wall box dimensions and pulmonary vein ostial dimensions were significantly larger in male patients than compared to female patients. There was no difference found in patients regarding LAA morphology.

Conclusion: Compared to male, female patients were older, had a higher BMI and had significantly smaller LA volumes, posterior wall box areas as well as PV ostial dimensions.  LAA morphology showed no difference in male compared to female patients.